Medicare plan to help seniors, jobs

Proposed improvements to Medicare Part D prescription drug plans would give seniors greater choice among pharmacies and more access to medication counseling to ensure proper drug use — and would keep more Medicare dollars here in Texas.

These pro-patient, pro-pharmacist provisions are part of a broader Medicare proposed rule that is open to public comment through Friday.

Currently the companies that administer Medicare drug plans — billion-dollar-middlemen known as pharmacy benefit managers (PBMs) — are increasingly entering into sweetheart deals with big-box pharmacies.

The PBMs unilaterally decide which pharmacies can serve as “preferred pharmacies” and then steer seniors toward them by offering reduced co-pays. Texas-based independent community pharmacies are routinely denied the ability to serve as “preferred” pharmacies.

It is bad enough that these exclusive arrangements in this taxpayer-funded program disadvantage small-business community pharmacies and those Medicare beneficiaries who prefer to “shop local” when it comes to their health care. What’s more, Medicare data shows that preferred pharmacy plans often result in higher costs.

The National Community Pharmacists Association recently compared the cost of 90-day supplies of four common drugs — generic versions of Lipitor, Plavix, diovan and Nexium — on a leading preferred pharmacy drug plan in nine cities across the country. According to Plan Finder, 89 percent of the time Medicare’s costs were higher when the prescriptions were filled at a “preferred pharmacy” compared to a non-preferred one, such as an independent pharmacy.

Medicare’s proposed rule would address this situation by simply giving independent community pharmacies the opportunity to participate in the same preferred contracts as big-box pharmacies. It would also ban PBM-generated sweetheart deals that often result in higher costs for Medicare.

Seniors would benefit from more pharmacy competition, and the proposal would result in no new Medicare costs.

This provision of the Medicare proposed rule is supported by a range of consumer groups including the Medicare Rights Center, the National Committee to Preserve Social Security and Medicare, and the National Council on Aging. There are Republican and Democratic members of Congress who support it as well.

Medicare’s proposal would also expand coverage of medication therapy management (MTM) services. These cost-saving medication reviews help ensure seniors adhere to their prescription drug therapy to improve their health and avoid more expensive healthcare services.

The proposed rule is not perfect, however. There are concerns about softening requirements that insurers cover certain drugs. Others are fearful of reducing the cap on the number of drug plans that a company can sponsor.

Both of these provisions should be carefully considered on their own respective pros and cons because they are completely separate from the pharmacy choice proposals described above.

Medicare’s common-sense proposal to let local pharmacies have the opportunity to accept preferred pricing contracts should be implemented because it would give seniors more choice and support Texas’ small business while better protecting the Medicare program and taxpayers.

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